The Nursing Workforce: Challenges for Community Health Centers and the Nation s Well-being

Transcription

1 The Nursing Workforce: Challenges for Community Health Centers and the Nation s Well-being Jane K Kadohiro, DrPH, APRN, CDE University of Hawaii at Manoa

2 Overview Today s nursing workforce Determinants of a health care workforce Recruitment barriers Retention barriers Strategies to address the issues

3 Who are today s nurses? Buerhaus (2007), Nursing Economics, 25(2), p79 Gender -Female 94% -Male 6% Age <25 years 2% years 10% years 40% years 37% > 61 years 8% Mean age is 48 years Ethnicity -White 77% -Black 5% -A/PI 7% -Hispanic 3% -Native Am <1% -Other <1% -Mixed 1% -Foreign born 14%

4 Education of today s nurses -AD 33.7 % -Diploma 17.5 % -BSN 34.2 % - Traditional - RN to BS - Accelerated -MSN & PhD 13 % Am. Nurses Assoc Nursing Economics 25(2) Masters Programs -APRN -NP -CNS -CNM -CRNA Doctoral Programs -PhD -DNS -DNP -related fields

5 Where do nurses work? Highest Degree Hospitals 56 % Community/PH 14.9% Ambulatory Care 11.5% Nursing Homes 6.3% Nursing Education 2.6% Work Setting -Urban 48% -Suburban 35% -Rural 16% Buerhaus (2007), pp

6 Nurse Vacancy Rates, 2005 * Hospitals 8.5 to 20% ** Dept of Veterans Affairs 10% Army, Navy, Air Force 10 to 40% * 83% of all nurses are employed in nursing ** 85% of hospitals reported a shortage 40% of all hospitals report shortages

7 Physician Shortages Projected overall need 3000 (30%) more med schools by 2015 Generalists and primary care providers 59% >> 32% (1949 > 2000) 51.6 % decrease ( ) Disproportions, urban rural Loss of PCPs 7 15% 24.7% Family MD shortages 13% 16%

8 Other Demographics and Trends Health care providers will retire at the same time demand will increase and the population of year olds will be decreasing Projected increase in U.S. patient population of minorities & underserved by 31% to 40% by 2020, yet workforce is not reflective of population served Only 64% of projected demand will be met by 2020

9 Demographics of rural populations and rural health workforce 40% of CHC patients are uninsured 35% of CHC patients are on Medicaid, and 70% live below the poverty line Increasing numbers of clients on Medicare 20% of the US pop. live in rural areas, yet only 9% of MDs practice in rural America Serious shortages of MD specialists Shortages of dentists, pharmacists, public health

10 Determinants of a Health Care Workforce Health care environment Economics Technology Regulatory and legislative actions Epidemiological factors Capacity for educating and preparing the workforce Demographics of the workforce and the population

11 Health Care Environment Teamwork, collegiality, relationships Role models and environment of caring Mutual respect & professional autonomy Time: to collaborate, to plan, to spend with patients Safety and quality of care Public image

12 Economics Specialty practices vs primary care Career opportunities Less income General non-work related issues

13 Technology Up to date equipment and supplies Telemedicine Training for use of technology Distance learning

14 Regulatory and Legislative Actions Meeting funding/grant requirements with inadequate workforce Programs intended to improve workforce supply, distribution, and diversity - federal support to train practitioners - foreign health care provider programs - Area Health Education Centers (AHEC) - Quentin Burdick Rural Interdisciplinary Teams - Tuition support or forgiveness programs

15 Epidemiological Factors Chronic conditions Greater acuity Geriatric care Substance use and abuse Mental health Homelessness Poverty Scarcity/distance of emergency rooms

16 Capacity for Educating and Preparing the Workforce Shortages of faculty, classrooms, and adequate clinical facilities Concentration for training is in urban centers Of qualified applicants to nursing schools, 147,000 are turned away annually

17 Recruitment Barriers Lack of employment opportunities for spouse Lack of cultural activities and opportunities Lack of adequate housing Poor quality schools Excessive workload * Inability to receive a competitive compensation package *

18 Barriers to recruitment of physicians & nurses in rural U.S. Barriers to Recruitment: RNs and MDs in Rural Areas Urban Rural Percent Spouse Employment Cultural Activities Housing Quality of Schools Workload Compensation Types of Barriers

19 Retention Barriers Inflexible work hours Excessive workload Required overtime Generous packages for fliers/other new staff without adjustments for existing More lucrative employment elsewhere Other more glamorous career options Lack of administrative and peer support Lack of respect; other interpersonal issues

20 Recruitment Strategies Education scholarships; tuition Service pay-back for loans J-1 Visa waivers Community outreach Work with schools Improve image of CHCs, nursing, and PCPs Increased advertising Build alliances and relationships Increase clinical placement opportunities Internship programs

21 Retention Strategies Establish career ladders Develop a mentoring system throughout Promote a sense of community and pride... a sense of ohana Offer flexible hours Prevent burnout Give retention bonuses Recognize and use each employee s

22 Overall Strategies to Improve Recruitment and Retention Education, scholarships, tuition Collect and study workforce data & trends Examine operations and staffing roles Improve communication; promote teamwork Increase nurse practitioner staff Greater visibility of CHCs advertising, etc Improve image of nurses, primary care docs Match minority staff with patient population Build community alliances & relationships Develop competitive compensation packages

23 Conclusions: Why a nursing shortage? A growing aging population Increased longevity An RN population at or approaching retirement High demand for the highest quality of care Retaining existing workforce Difficulty recruiting into nursing Aging educators and inadequate clinical resources

24 A look to the future What will be the health care demands of the population? Where will patients receive health care services? What level of services will patients require? Who will provide what services? Pipeline planning is essential!

25 The time to plan is now... By 2020, only 64% of the projected demand will be met!

26 IMUA!

27 Impact of the Nursing Shortage on Nursing Practice Impact identified as major problem by RNs *Less time to collaborate w teams 55% 51% *Early detection of complications 62% 58% *Ability to maintain patient safety 68% 63% *Quality of patient care 80% 70% *Work life quality 83% 72% *Time with patients 93% 82%

28 Quality of Current Work Setting as Rated by Nurses Quality Rated Excellent or V.Good *Salaries and benefits 16% 28% *Flexibility of schedule 31% 36% *Opportunity to influence decisions re: work and organization 15% 17% *Recognition for accomplishments and work well done 21% 18% *Opportunity for prof.development 17% 20% *Opportunity for advancement 17% 16%

29 Impact of Nursing Shortage on Direct Patient Care Type of Impact Observed by RNs *Delayed responses to calls, pages 89% 72% *Staff communication problems 88% 72% *Patient complaints re: nursing care 87% 69% *Increased wait time for patients 75% 60% *Delayed discharge from hospital 72% 64% *Extra workload on physicians 53% 51% *Decreased/ceased patient programs 42%

30 Job and Career Satisfaction of RNs Very satisfied with Current job 13% 29% Being a nurse 35% 55%